Limited Awareness of Melioidosis in High-risk Populations Despite an Increasing Incidence of the Disease in Far North Queensland, Australia.

The incidence of melioidosis, an opportunistic infection caused by Burkholderia pseudomallei, has recently doubled in Far North Queensland (FNQ), Australia. This contrasts with the local burden of dengue, which is nearing elimination, and the stable incidence of leptospirosis. This questionnaire-based study assessed the awareness of melioidosis among people in FNQ with risk factors for the disease, using awareness of leptospirosis and dengue as comparators. There were 427 respondents; 361 (85%) reported one or more risk factors for melioidosis. Only 69 of 361 (19%) had heard of melioidosis compared with 301 of 361 (83%) who had heard of dengue (P < 0.001) and 137 of 361 (38%) who had heard of leptospirosis (P < 0.001). In FNQ, Australia, there is an increasing local incidence of melioidosis, but there is limited awareness of the disease among high-risk individuals. Greater community awareness of melioidosis is necessary to implement strategies to prevent disease and expedite the presentation of patients with this life-threatening infection.

Investigation of febrile passengers detected by infrared thermal scanning at an international airport.

OBJECTIVE: To determine the best approach for the evaluation of fever, detected by infrared thermal scanning, at an international airport. METHODS: Arriving passengers with fever were divided into three groups: community evaluation by a GP, with or without cost compensation, or evaluation at the airport by a health practitioner. Uptake of offered evaluations was measured, diagnoses were recorded, and region-specific rates of fever measured. Observations were made on practical aspects of thermal screening. RESULTS: Over a six-month period, 181,759 passengers were screened for fever at the Cairns international airport, Queensland, Australia. Fever was identified in 118 (0.06%) of the arriving passengers and 76 were enrolled in the study. Only 19 of these passengers (25%) voluntarily underwent further evaluation. No differences were observed in the three approaches. CONCLUSIONS: Public health surveillance of febrile passengers arriving at an international airport should not rely on voluntary passenger participation for the detection of imported contagious diseases.

Barriers to use of information and computer technology by Australia's nurses: a national survey.

AIMS AND OBJECTIVES: To support policy planning for health, the barriers to the use of health information and computer technology (ICT) by nurses in Australia were determined. BACKGROUND: Australia, in line with many countries, aims to achieve a better quality of care and health outcomes through effective and innovative use of health information. Nurses form the largest component of the health workforce. Successful adoption of ICT by nurses will be a requirement for success. No national study has been undertaken to determine the barriers to adoption. DESIGN: A self-administered postal survey was conducted. METHOD: A questionnaire was distributed to 10,000 members of the Australian Nursing Federation. Twenty possible barriers to the use of health ICT uptake were offered and responses were given on a five point Likert scale. RESULTS: Work demands, access to computers and lack of support were the principal barriers faced by nurses to their adoption of the technology in the workplace. Factors that were considered to present few barriers included age and lack of interest. While age was not considered by the respondents to be a barrier, their age was positively correlated with several barriers, including knowledge and confidence in the use of computers. CONCLUSIONS: Results indicate that to use the information and computer technologies being brought into health care fully, barriers that prevent the principal users from embracing those technologies must be addressed. Factors such as the age of the nurse and their level of job must be considered when developing strategies to overcome barriers. RELEVANCE TO CLINICAL PRACTICE: The findings of the present study provide essential information not only for national government and state health departments but also for local administrators and managers to enable clinical nurses to meet present and future job requirements.

Strategies for success: a toolbox of coping strategies used by breastfeeding women.

AIMS: The purpose of this paper is to present the findings of two qualitative studies which identified strategies used by breastfeeding women to assist them to continue breastfeeding. BACKGROUND: While breastfeeding initiation rates are high in Australia, the majority of women wean before the recommended time. The identification of interventions which may increase breastfeeding duration is therefore a research priority. DESIGN: The Against All Odds study used a case-controlled design to investigate the characteristics of women who continued to breastfeed in the face of extraordinary difficulties. Phase One of the I Think I Can study employed the Nominal Group Technique to investigate the views of subject matter experts regarding which psychological factors may influence the duration of breastfeeding. METHOD: Against All Odds study participants (n = 40) undertook a one- to two-hour interview and the transcribed data were analysed using thematic analysis. Stratified purposeful sampling was employed in the I Think I Can study (n = 21), with participants assigned group membership according to their most recent breastfeeding experience. A fourth group was composed of experienced breastfeeding clinicians. The nominal group technique was used to generate group data and segments of the discussion were audiotaped and transcribed for thematic analysis. RESULTS: Participants in both the studies raised strategies used to assist them in their efforts to cope with the challenges of breastfeeding and early motherhood. These strategies included increasing breastfeeding knowledge, staying relaxed and 'looking after yourself', the use of positive self-talk, challenging unhelpful beliefs, problem solving, goal setting and the practice of mindfulness. CONCLUSIONS: Employment of these simple behavioural and cognitive strategies may assist women to cope with the pressures inherent in the experience of early mothering, thereby increasing the duration of breastfeeding. RELEVANCE TO CLINICAL PRACTICE: These results may represent a 'tool box' of coping strategies which can be provided to women for use in the postnatal period.

Exploring the influence of psychological factors on breastfeeding duration, phase 1: perceptions of mothers and clinicians.

Breastfeeding duration rates in Australia are low, prompting a search for modifiable factors capable of increasing the duration of breastfeeding. In this study, participants were asked which psychological factors they believed influence breastfeeding duration. Participants included 3 groups of mothers who had breastfed for varied lengths of time (n = 17), and 1 group of breastfeeding clinicians (n = 4). The nominal group technique was employed, involving a structured group meeting progressing through several steps. Analyses included collation of individual and group responses, group comparisons, and a thematic analysis of group discussions. Forty-five psychological factors thought to influence the duration of breastfeeding were identified. Factors considered most important included the mother's priorities and mothering self-efficacy, faith in breast milk, adaptability, stress, and breastfeeding self-efficacy. In addition to informing the design of phase 2 of this study, these results add to our knowledge of this emerging research area.

Attitudes of Australian nurses to information technology in the workplace: a national survey.

This article reports on the views of Australian nurses as to their use of computers in the workplace. Data were collected by questionnaires mailed to 10,000 members of the 150,000-member Australian Nursing Federation, which represents 60% of the Australian nursing workforce. The response rate was 43.3%. Computer use was 20% by assistants in nursing, rising to 75% by enrolled nurses and to more than 95% by RNs. Principal uses for the computers by the nurses were for access to patients' records and for internal communication. Most respondents (79%) agreed that the use of computers had improved information access. Only 9.4% considered that adoption of a national electronic health record would not be useful to healthcare. Fewer than 5% stated that they have no interest in computers, and 87% considered that their age was never or rarely a barrier to their use of the technology. However, not all aspects of computer introduction to nursing were positive. The proportions of respondents who considered that the use of computers had made their work easier, reduced duplication of data entry, and reduced errors in handing patient data were only 42%, 32%, and 31%, respectively. Results demonstrate a positive attitude toward information technology by Australian nurses but identify issues that must be addressed to support continued interest and engagement.

The status of training and education in information and computer technology of Australian nurses: a national survey.

AIMS AND OBJECTIVES: A study was undertaken of the current knowledge and future training requirements of nurses in information and computer technology to inform policy to meet national goals for health. BACKGROUND: The role of the modern clinical nurse is intertwined with information and computer technology and adoption of such technology forms an important component of national strategies in health. The majority of nurses are expected to use information and computer technology during their work; however, the full extent of their knowledge and experience is unclear. DESIGN: Self-administered postal survey. METHODS: A 78-item questionnaire was distributed to 10,000 Australian Nursing Federation members to identify the nurses' use of information and computer technology. Eighteen items related to nurses' training and education in information and computer technology. RESULTS: Response rate was 44%. Computers were used by 86.3% of respondents as part of their work-related activities. Between 4-17% of nurses had received training in each of 11 generic computer skills and software applications during their preregistration/pre-enrolment and between 12-30% as continuing professional education. Nurses who had received training believed that it was adequate to meet the needs of their job and was given at an appropriate time. Almost half of the respondents indicated that they required more training to better meet the information and computer technology requirements of their jobs and a quarter believed that their level of computer literacy was restricting their career development. Nurses considered that the vast majority of employers did not encourage information and computer technology training and, for those for whom training was available, workload was the major barrier to uptake. Nurses favoured introduction of a national competency standard in information and computer technology. CONCLUSIONS: For the considerable benefits of information and computer technology to be incorporated fully into the health system, employers must pay more attention to the training and education of nurses who are the largest users of that technology. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the training and education needs of clinical nurses with respect to information and computer technology will provide a platform for the development of appropriate policies by government and by employers.

The influence of psychological factors on breastfeeding duration.

AIM: This paper reports on a study examining the relationship between women's psychological characteristics and breastfeeding duration, after controlling for socio-demographic factors. BACKGROUND: The literature suggests that psychological factors may influence breastfeeding behaviour, but studies are few. Existing evidence and the results of phase 1 of our study were used to construct a list of psychological factors, which were tested for their association with breastfeeding duration in the current design. METHOD: Participants were postnatal inpatients in one of two regional hospitals between October and December 2005 and they completed the initial questionnaire within 14 days of giving birth (n = 375). Infant feeding method at 6 months and the timing of introduction of other food(s), where relevant, were ascertained by telephone interview. FINDINGS: Forty-four per cent of the sample showed signs of postnatal distress in the 14 days following the birth. Breastfeeding duration was statistically significantly associated with psychological factors including dispositional optimism, breastfeeding self-efficacy, faith in breastmilk, breastfeeding expectations, anxiety, planned duration of breastfeeding and the time of the infant feeding decision. As a set, these psychological factors were more predictive of breastfeeding duration than was the set of socio-demographic characteristics. The duration of any breastfeeding was uniquely predicted by faith in breastmilk, planned breastfeeding duration and breastfeeding self-efficacy. CONCLUSION: This increased knowledge of the factors influencing breastfeeding will assist in identifying women at risk of early weaning and in constructing programmes capable of increasing the length of time for which women breastfeed.

Informing rural and remote students about careers in health: factors influencing career decisions.

OBJECTIVE: Since 1994 a state-wide program has been operating in Queensland to provide non-metropolitan secondary school students with information about health careers. Determination of the factors influencing the career decisions of rural and remote students was one objective of the evaluation of that program. DESIGN: Telephone interviews. SETTING: Secondary schools. SUBJECTS: People who had previously attended Year 10 residential health career workshops run by Queensland Health. Ninety-four of 277 past participants to Year 10 Health Careers Workshops responded to a postal questionnaire and were invited to take part in a telephone questionnaire to collect further information related to the course and career choices. MAIN OUTCOME MEASURES: Self-reported factors affecting career decisions of students from rural and remote areas. RESULTS: Of the 94 past workshop participants, interviews were held with 70. All participants had left secondary education and had either undertaken or were undertaking some form of tertiary study. The most influential of nine factors to both undergraduate and postgraduate course choices was self-interest. Various other factors differentially contributed to undergraduate and postgraduate course choices among them were the health careers workshops, which played a major influence on undergraduate course decisions of students. CONCLUSION: Self-interest is the largest self-reported factor to career decision making among students from rural and remote areas. Finance and career advice from school are not considered to be highly influential. However, these independent decisions can be substantially influenced by external information provided through health career workshops.

Rural men and mental health: their experiences and how they managed.

There is a growing awareness that a primary source of information about mental health lies with the consumers. This paper reports on a study that interviewed rural men with the aim of exploring their mental health experiences within a rural environment. The results of the interviews are a number of stories of resilience and survival that highlight not only the importance of exploring the individuals' perspective of their issues, but also of acknowledging and drawing on their inner strengths. Rural men face a number of challenges that not only increase the risk of mental illness but also decrease the likelihood of them seeking and/or finding professional support. These men's stories, while different from each other, have a common thread of coping. Despite some support from family and friends, participants also acknowledged that seeking out professional support could have made the recovery phase easier. Mental health nurses need to be aware, not only of the barrier to professional support but also of the significant resilience that individuals have and how it can be used.

Aged care nursing in Queensland - the nurses' view.

AIMS AND OBJECTIVES: Through comparison of two studies undertaken three years apart the opinions of nurses working in aged care facilities in Queensland were determined. Results will support policy planning for the Queensland Nurses Union. BACKGROUND: An ageing population in Australia is placing increased demands on residential aged care facilities. In Queensland, the national situation is exacerbated by an influx of retirees from other states and territories. The ongoing problem of shortages of nurses in the workforce may be addressed by gaining further insight into the nurses' own views of their conditions and experiences. METHODS: One thousand nurses working in public and privately owned residential aged care facilities were surveyed by postal questionnaire in 2004. Results were compared with data collected in an identical study in 2001. RESULTS: Respondents offered their opinions on working hours and conditions, professional development and experiences in nursing. The predominately female aged care nursing workforce is ageing. Reported workplace violence has increased substantially since 2001. Some improvements are reported in staff numbers, skill mix and workplace policies. Nurses expressed very serious concerns about pay, workload, stress, physical and emotional demands and staff morale. CONCLUSION: Working conditions for nurses in the residential aged care sector in Queensland must be addressed to retain the current nurses and to encourage new nurses to replace those that retire. RELEVANCE TO CLINICAL PRACTICE: The findings of this study provide information not only for the Queensland Nurses Union but also policy makers and nurse managers both nationally and internationally on areas that need to be addressed to maintain the required workforce within the aged care sector.

Tenure, mobility and retention of nurses in Queensland, Australia: 2001 and 2004.

AIM: Data were collected on tenure, mobility and retention of the nursing workforce in Queensland to aid strategic planning by the Queensland Nurses Union (QNU). BACKGROUND: Shortages of nurses negatively affect the health outcomes of patients. Population rise is increasing the demand for nurses in Queensland. The supply of nurses is affected by recruitment of new and returning nurses, retention of the existing workforce and mobility within institutions. METHODS: A self-reporting, postal survey was undertaken by the QNU members from the major employment sectors of aged care, public acute and community health and private acute and community health. RESULTS: Only 60% of nurses had been with their current employer more than 5 years. In contrast 90% had been in nursing for 5 years or more and most (80%) expected to remain in nursing for at least another 5 years. Breaks from nursing were common and part-time positions in the private and aged care sectors offered flexibility. CONCLUSION: The study demonstrated a mobile nursing workforce in Queensland although data on tenure and future time in nursing suggested that retention in the industry was high. Concern is expressed for replacement of an ageing nursing population.

Psychological services in five South-west Queensland communities--supply and demand.

INTRODUCTION: This research gathered information in 2004 about psychological services provided to five rural communities located in South-west Queensland, Australia. Specifically, the aims of the project were to: (i) undertake an audit of existing psychological services; and (ii) determine the need for psychological services as perceived by providers of current services. METHODS: Potential providers of psychological services were contacted to confirm the nature and extent of their provision of psychological support to target communities. Thirty organisations met the definition of service providers offering assessment or intervention by qualified and/or experienced persons. Data were collected by semi-structured telephone interviews with 44 employees of the service providers. RESULTS: The one main publicly-funded provider of services to the region offered limited services to the communities. Although some counselling was provided by social workers attached to the allied health program, for patients to be supported by the mental health sector of this service, they must have had moderate to severe mental illness. Regular, reliable and accessible psychological support for other conditions was limited largely to services provided by non-government organisations (NGOs) which are often constrained by continuity of funds. Counselling for alcohol and drug misuse, women's issues, sexual abuse, and crisis support were the most commonly identified unmet needs across the target communities. Difficulties in attracting experienced personnel to work in rural communities were reported. This was exacerbated by lack of job security brought about by short term funding to the NGOs. In general, unqualified counsellors were recognised as providing valuable services. CONCLUSIONS: There are limited psychological support services provided to these South-west Queensland communities. For available services, there are strict criteria for entry, limited accessibility and availability or lack of continuity owing to short-term funding. There are a number of unmet psychological needs, with abuse being the most widely identified. Any withdrawal of existing psychological services is perceived by current service providers as being potentially devastating.

Informing rural and remote students about careers in health: the effect of Health Careers Workshops on course selection.

OBJECTIVE: Since 1994, as part of the Health Careers in the Bush program, Queensland Health has run residential workshops to provide secondary school students from rural and remote areas with information about health careers. This study reports on the influence of the program on tertiary course selection. DESIGN: Self-administered mail survey and telephone interviews. SETTING: Secondary schools. PARTICIPANTS: Past students who had in year 10 attended residential career workshops run by Queensland Health. MAIN OUTCOME MEASURES: Tertiary courses; self-reported influence of the workshop program on raising awareness and course selection. RESULTS: Over 90% of participants reported that the workshops had a major impact on their course and career selection. The workshops provided exposure to a wide variety of health-related disciplines, enabling students to be better informed about their course and career plans within the industry. Half of the students changed their course as a result of attending a workshop, and 83% enrolled in a health-related course. The 17% who did not enrol in a health-related course also recognised the value of the workshop program. CONCLUSION: The workshop program raised awareness of health professions and offered valuable information to rural students about a wide range of health careers. Results suggest that provision of such information in a residential-workshop format contributed significantly to tertiary course selection of rural and remote students. The benefit to the health industry from these workshops has been substantial in relation to the small amount of funds invested.

Workforce issues in nursing in Queensland: 2001 and 2004.

AIM AND OBJECTIVES: The aim of the study was to identify the factors having an impact upon nursing work and to use the results to inform strategic planning of the Queensland Nurses Union. BACKGROUND: In 2001 and 2004, a study was undertaken to gather data on the level of satisfaction of nurses with their working life. This paper reports the 2004 results on workload, skill mix, remuneration and morale. Where applicable, the results are compared with 2001 data. METHODS: A questionnaire was mailed to 3000 Assistants-in-Nursing, Enrolled and Registered Nurses in October 2004. All participants were members of the Queensland Nurses Union. The results are reported in three sectors - public, private and aged care. A total of 1349 nurses responded to the survey, a response rate of 45%. RESULTS: Nurses in the 2004 study believed: their workload was heavy; their skills and experience poorly rewarded; work stress was high; morale was perceived to be poor and, similar to 2001, deteriorating; the skill mix was often inadequate; and the majority of nurses were unable to complete their work in the time available. Nursing morale was found to be associated with autonomy, workplace equipment, workplace safety, teamwork, work stress, the physical demand of nursing work, workload, rewards for skills and experience, career prospects, status of nursing and remuneration. CONCLUSIONS: Overall the findings of the study are consistent with those determined by the 2001 survey. RELEVANCE TO CLINICAL PRACTICE: The findings of this study indicate the importance of factors such as workplace autonomy, teamwork, the levels of workplace stress, workload and remuneration on nursing morale. The data also indicate that workplace safety and workplace morale are linked. These findings provide information for policy makers and nurse managers on areas that need to be addressed to retain nurses within aged care, acute hospital and community nursing.

Australian nurses access and attitudes to information technology--a national survey.

Competencies by nurses in information technology (IT) are essential to health care in Australia yet data suggest deficiencies in access and use. A study commissioned by the Australian Government aimed to determine the extent of access and use and the barriers to the use of IT among nurses across Australia. A survey was distributed to 10,000 members of the Australian Nursing Federation with a 43% overall response rate. Fewer than 15% of nurses did not use computers as part of their work. The greatest use was for client records, patient pathology and radiology results and professional development. IT uptake in health is supported by nurses who are, however frustrated by limitations to access and software that is not fit for purpose. A lack of confidence in using IT was noted by many nurses. Fewer than 20% had received pre-registration training in any aspect of IT and only 30% post registration. In addition to training, high work load, numbers of computers and inadequate technical support were the major barriers to computer use.

Nurse discharge planning in the emergency department: a Toowoomba, Australia, study.

AIM: This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re-presentations and readmissions and the length of stay of older people presenting to an Australian emergency department. OBJECTIVES: The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of re-presentations and readmissions within this cohort of patients; and (iii) risk-screen all older patients and provide referrals when necessary to community services. DESIGN: The study involved the application of a risk screening tool to 2,139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1,102 (51.5%) were admitted and 246 (11.5%) were re-presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk-screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted. RESULTS: There was a 16% decrease in the re-presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5.5% decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6.17 days per patient in October 2002 to 5.37 days per patient in June 2003. An unexpected finding was the decrease in re-presentations in people who represented to the emergency department three or more times per month (known as 'frequent flyers'). CONCLUSIONS: Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re-presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re-presentations was the result of increased referral and use of community services. It appears that the use of a specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization. RELEVANCE TO CLINICAL PRACTICE: It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient.

Workplace violence in Queensland, Australia: the results of a comparative study.

This paper presents the results on workplace violence from a larger study undertaken in 2004. Comparison is made with the results of a similar study undertaken in 2001. The study involved the random sampling of 3,000 nurses from the Queensland Nurses' Union's membership in the public (acute hospital and community nursing), private (acute hospital and domiciliary nursing) and aged care (both public and private aged care facilities) sectors. The self-reported results suggest an increase in workplace violence in all three sectors. Although there are differences in the sources of workplace violence across the sectors, the major causes of workplace violence are: clients/patients, visitors/relatives, other nurses, nursing management and medical practitioners. Associations were also found between workplace violence and gender, the designation of the nurse, hours of employment, the age of the nurse, morale and perceptions of workplace safety. Although the majority of nurses reported that policies were in place for the management of workplace violence, these policies were not always adequate.

SEAM--improving the quality of palliative care in regional Toowoomba, Australia: lessons learned.

INTRODUCTION: The proliferation of professional palliative care services in recent years has increased access for people with palliative care needs; however, gaps in services continue to exist, particularly in rural and remote areas of Australia. In order to address one gap in rural health service delivery, the Support, Education, Assessment, and Monitoring (SEAM) Service for regional and rural people in Toowoomba, Queensland, Australia, was introduced. This new model of service delivery aimed to provide palliative services to patients and their families who live in the regional city of Toowoomba and its rural catchment area. It also aimed to facilitate education, support and networking among health-care professionals, particularly general practitioners and nurses employed in general practice (practice nurses). METHOD: The evaluation involved twenty face-to-face interviews with a variety of health professionals who had contact with the SEAM service from June 2003 to June 2004. Qualitative data analysis of the transcribed interviews provided the basis for the evaluation. The emergent themes regarding the SEAM service included: satisfaction and benefit of the SEAM service; knowledge of and contact with the SEAM service; the SEAM role; and expansion of the role. RESULTS: The data indicate that the majority of health professionals who had contact with the SEAM service were satisfied with the service and found it to be of benefit to them and their clients. Participants commented on the extensive networking and support work established by the SEAM nurse with other health service providers. Difficulties experienced with the SEAM service included poor utilisation by GPs and, therefore, clients in need of palliative support. This was predominately due to lack of knowledge of the service as well as limited understanding of the SEAM nurse role. CONCLUSION: The SEAM service has resulted in increased links between health professionals providing palliative care to rural clients. The most successful strategy was the use of multidisciplinary case conferencing which not only built links among health professionals caring for individual clients, but also resulted in improved care for those clients. As a result of better integration and communication, palliative care services to rural people have been improved. However, with regard to the delivery of direct patient care, or in the support of GPs for the management of palliative care patients, it was apparent that the service did not meet its objectives. The lack of use by GPs and patients appears to be related to a lack of awareness of the existence of the service. A positive outcome of this poor utilisation is, however, that the model has allowed the identification of factors that work as barriers to GPs and client/family utilisation of rural palliative care services.

Implementation of oral health recommendations into two residential aged care facilities in a regional Australian city.

Background Residents of aged care facilities usually have a large number of oral health problems. Residents who suffer from dementia are at particular risk. A systematic review of the best available evidence with regard to maintaining the oral health of older people with dementia in residential aged care facilities provided a number of recommendations. Objectives The aim of the implementation project was to introduce evidence-based oral hygiene practices for patients with dementia in two publicly funded residential aged care facilities and monitor for changes in nursing awareness, knowledge, documentation and practice to improve patient outcomes and ensure appropriate accreditation standards were met. An additional aim was to identify barriers and strategies to overcome barriers to implementation of evidence-based recommendations. Methods Two facilities, a 40-bed facility and a 71-bed facility in the health service district of the regional Australian city of Toowoomba, provided the setting. A quality improvement approach was taken, using a number of strategies from the National Health and Medical Research Council guidelines for implementation studies. The implementation involved a number of stages, including project development, interactive oral health education, oral audits of residents, changes to oral hygiene practice via care plans and critical reflection. Results The multidisciplinary approach to improving oral healthcare appeared to improve knowledge and awareness and move oral health practices in facilities closer to best practice. Specialised training in oral health was provided to a Clinical Nurse Consultant. Regular oral audits were introduced and facility staff were trained in the use of the oral audit tool. Care plans at one facility were of better quality and more comprehensive than before the intervention. Comments made during critical reflection suggested improvements in the oral health of residents, increased use of oral swabs and saliva substitutes, improved care of dentures and mention of the use of mouth props in resident care plans. There was also some evidence that changes brought about by the implementation are sustainable. Conclusion The majority of recommendations provided in the systematic review of oral healthcare for dementia patients were applicable to the applied context. The importance of day-to-day leaders was highlighted by the apparently varied outcomes across target facilities. The quality improvement approach would appear to have considerable advantages when applied to improving practice in residential aged care.